Presentation
A 29-year-old Nigerian male presented with high fever, vomiting, diarrhea and altered mental status. He had previously been diagnosed with malaria 5 days prior and was receiving treatment with an unknown medication. A physical exam revealed tender hepatomegaly and conjunctival icterus. Initial laboratory studies showed severe anemia and thrombocytopenia, with hemoglobinuria, bilirubinuria and proteinuria on urinalysis. Giemsa-stained thick and thin smears show ring-shaped intracellular organisms. Due to a shortage of coartem, quinine was administered. Shortly after, the patient’s urine turned dark brown.
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This case study is in collaboration with Bobbi Pritt, M.D., M.S., Mayo Clinic, and her blog, “."
Author Information
Curtiss Johnson, D.O., AP/CP Resident, Mayo Clinic, Rochester.
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